Anticoagulant Therapy

The most current guidelines for the use of warfarin (Coumadin) for cardiovascular diseases are found in the Cardiovascular Advisory Panel Guidelines for the Medical Examination of Commercial Motor Vehicle Drivers.

Anticoagulant therapy may be utilized in the treatment of cardiovascular or neurological conditions. The guidelines emphasize that the certification decision should be based on the underlying medical disease or disorder requiring medication, not the medication itself.

Waiting period

Minimum — 1 month stabilized

NOTE: If more than one waiting period applies (because of multiple cardiac conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.

Decision

Maximum certification period — 1 year

Recommend to certify if:

The driver:

• Is stabilized on medication for at least 1 month.
• Provides a copy of the international normalized ratio (INR) results at the examination.
• Has at least monthly INR monitoring.

Recommend not to certify if:

• INR is not being monitored.
• INR is not therapeutic.
• Underlying disease is disqualifying.

Monitoring/Testing

The driver should obtain INR monitoring at least monthly.

Follow-up

The driver should bring results of INR monitoring to the examination.

Venous Disease Recommendation Tables (PDF) — Coumadin

Waiting period

Not applicable.

Decision

Recommend to certify if:

Not applicable.

Recommend not to certify if:

The driver has a cerebrovascular disorder.

NOTE: The rationale for disqualification is the high rate of complications associated with bleeding that can incapacitate the driver while operating a vehicle.

Monitoring/Testing

Not applicable.

Follow-up

Not applicable.

The complete text of the medical conference reports can be accessed from FMCSA Medical Reports.